The application of a multidisciplinary approach in the diagnosis of Castleman disease and Castleman-like lymphadenopathies: A 20-year retrospective analysis of clinical and pathological features.

BACKGROUND: Castleman disease (CD) comprises a group of rare and heterogeneous haematological disorders, including unicentric (UCD) and multicentric (MCD) forms, the latter further subdivided into HHV8-MCD, POEMS-MCD and idiopathic-MCD (iMCD). However, according to the Castleman Disease Collaborative Network guidelines, the diagnosis of CD can only be achieved through collaboration between clinicians and pathologists. METHODS: We applied these clinical and pathological criteria and implement with clonality testing to a retrospective cohort of 48 adult and paediatric Italian patients diagnosed with reactive lymphadenitis with CD-like histological features. RESULTS: We confirmed the diagnosis of CD in 60% (29/48) of the cases, including 12 (41%) UCD and 17 (59%; five HHV8-MCD, three POEMS-MCD and nine iMCD) MCD. Of the remaining 19 cases (40%) with multiple lymphadenopathy, 5 (26%) were classified as autoimmune diseases, 1 (5%) as autoimmune lymphoproliferative disorder, 1 (5%) as IgG4-related disease, 11 (83%) as reactive lymphadenitis and 1 (5%) as nodal marginal zone lymphoma. CONCLUSIONS: Our study emphasizes the importance of the multidisciplinary approach to reactive lymphadenitis with CD-like features in order to achieve a definitive diagnosis and choose the appropriate treatment.

Papain Covalent Immobilization in Bacterial Cellulose Films as a Wound Dressing.

Ideally, the dressings used in the clinic have characteristics that help the wound closure process. Among several factors that affect the success of this healing process, there is debridement. It manages the wound bed components and the re-epithelialization process. Still, the property of debridement is not generally associated with dressings. Here, we show a chemically modified bacterial cellulose film conjugated to a proteolytic enzyme, papain, as a dressing with debridement properties. Bacterial cellulose films were reacted with a spacer derived from succinic acid and finally had this enzyme covalently immobilized in its structure by an amide bond. FT-IR and UV-vis showed bands typically of bioconjugated polymer. Enzymatic immobilization was very effective under the conditions applied with high yield (33% w/w), and these remained activated after the coupling reaction. The bacterial cellulose film with the enzyme papain attached to it was also very compatible with fibroblast cells, suggesting that it could be a promising wound dressing material for future research.

Effects of exercises performed in the work environment on occupational stress: A systematic review.

INTRODUCTION: Technological advances stimulate labor transformations in such a way that the search for productivity, goals and market competitiveness leads industries and companies to neglect the health and safety of their workers. There is a gap in the literature regarding means of intervention using physical exercises (PE), with details remaining unknown in terms of appropriate exercise prescriptions or types that minimize the effects of occupational stress. OBJECTIVE: to verify the effects on workers' stress of PE performed in the work environment. METHOD: this systematic review searched for randomized controlled trials (RCTs) in 08 databases (MEDLINE, Cochrane, BIREME, LILACS, EBSCOhost, SCOPUS, Web of Science and Embase), in English and Portuguese, published between 2017 and 2021. The PICOS strategy was used to determine inclusion, being P: male and female workers; I: exercises performed in the work environment; C: control group without intervention; O: occupational stress; and S: controlled experiments. Methodological quality, risk of bias and reliability of assessments were analyzed using the TESTEX, Risk of Bias 2, and Kappa scales. RESULTS: A total of 07 articles were included, of which, most had good methodological quality and unclear risk of bias. The intra- and inter-rater reliability test of methodological quality showed excellent agreement. As a limitation, the fragility in allocation concealment, blinding and absence of treatment analysis was noted in the studies evaluated. CONCLUSION: PE in the workplace might have positive effects on reducing occupational stress, but further studies must be conducted to better clarify this. This review was registered with PROSPERO (CRD42022304106).

Depressão em idosos: uma visão Winnicottiana / Depression in the elderly: a Winnicottian view

Como uma questão de saúde pública na atualidade, a depressão exige reflexões e práticas que ofereçam tratamento compatível às suas necessidades de cuidado. Os idosos são um dos grupos que mais apresentam demandas ligadas aos estados de humor deprimido, variando em sua intensidade e gravidade. A partir da visão winnicottiana, o artigo explora tal fenômeno sob duas conjunturas: a depressão como uma conquista da capacidade de deprimir-se diante de perdas e frustrações; a depressão como incapacidade de tolerar impulsos agressivos básicos, tendo como realidade a obstrução do processo de maturação. Apresenta especificidade do tratamento, enfatizando o potencial terapêutico das relações de cuidado e a relevância da atenção profissional interdisciplinar.(AU)

As a current public health issue, depression requires reflections and practices that offer treatment compatible with the person’s care needs. The elderly is one of the groups that most present demands related to depressed mood states, varying in intensity and severity. From this viewpoint, the article explores this phenomenon under two circumstances: depression as an achievement of the ability to depress oneself due to losses and frustrations; and depression as an inability to tolerate basic aggressive impulses, with the reality of obstructing the maturation process. It presents the specificity of treatment, emphasizing the therapeutic potential of care relationships and the relevance of interdisciplinary professional care.(AU)

Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers.

Introduction: The aim of the present study is to report the outcome of patients presenting an isolated type II endoleak (TIIEL) requiring reintervention and to identify clinical and anatomical characteristics potentially implicated in refractory TIIEL occurrence and fate. Materials and Methods: A multicenter retrospective study on TIIEL requiring reintervention was conducted between January 2003 and December 2020. Demographic and clinical characteristics, procedural technical aspects, reinterventions, and outcomes were recorded. TIIEL determining sac expansion greater than 10 mm underwent a further endovascular procedure aiming to exclude aneurismal sac. Redo endovascular procedures were performed via endoleak nidus direct embolization and/or aortic side branches occlusion. TIIELs responsible for persisting aneurysmal sac perfusion 6 months after redo endovascular procedures were classified as "refractory" and submitted to open conversion. Results: A total of 102 TIIEL requiring reintervention were included in the final analysis. Eighty-eight (86.27%) patients were male, the mean age was 77.32 ± 8.08 years, and in 72.55% of cases the American Society of Anaesthesiologists (ASA) class was ≥3. The mean aortic diameter was 64.7 ± 14.02 mm, half of treated patients had a patent inferior mesenteric artery (IMA), and 44.11% ≥ 3 couples of patent lumbar arteries (LA). In 49 cases (48.03%) standard endovascular aneurysm repair (EVAR) procedure was completed without adjunctive maneuvers. All enrolled patients were initially submitted to a further endovascular procedure once TIIEL requiring reintervention was diagnosed; 57 patients underwent LAs or IMA embolization (55.87%), 42 transarterial aneurismal sac embolization (41.17%), and three (2.96%) laparoscopic ostial ligations of the inferior mesenteric artery. During a mean follow-up of 15.22 ± 7.57 months (7−48), a redo endovascular approach was able to ensure complete sac exclusion in 52 cases, while 50 patients presented a still evident refractory TIIEL and therefore a surgical conversion or semiconversion was conducted. At the univariate analysis refractory TIIEL patients were significantly different from those who did not develop the complication in terms of preoperative clinical, morphological characteristics, and initial EVAR procedures: coronary artery disease occurrence (p = 0.005, OR: 3.18, CI95%: 1.3−7.2); preoperative abdominal aortic aneurysm (AAA) sac diameter (p = 0.0055); IMA patency (p = 0.016, OR: 2.64, CI95%: 1.18−5.90); three or more patent LAs; isolated standard EVAR without adjunctive procedures (p > 0.0001; OR: 9.48, CI95%: 3.84−23.4). Conclusions: Our experience seems to demonstrate that it is reasonable to try to preoperatively identify those patients who will develop a refractory TIIEL after EVAR and those with a TIIEL requiring reintervention for whom a simple endovascular redo will not be enough, needing surgical conversion.

Narrative review about kip's execution on the low bar of uneven bars / Revisão narrativa sobre a execução do kip na barra baixa das paralelas assimétricas

O kip é uma habilidade fundamental amplamente utilizada nas rotinas de treinamento da ginástica artística. No entanto, faltam materiais didáticos que auxiliem o processo de ensino-aprendizagem dos alunos e dos professores iniciantes. OBJETIVO: Apresentar uma análise biomecânica qualitativa do kippe realizado na barra inferior das paralelas assimétricas. MÉTODOS: Esta foi uma revisão narrativa baseada no Google Acadêmico. Os termos utilizados para a busca dos materiais foram kippe e biomecânica, em Português e Inglês, considerando estudos experimentais e não experimentais. RESULTADOS: A literatura aponta diferentes termos para designar este mesmo movimento. Os movimentos articulares predominantes são extensão e flexão, o que justifica a maioria dos textos abordar a análise do plano sagital. O kippe tem seis instantes e três fases de movimento, Glide, Pike e Pull Up. A literatura mostra pequenas diferenças na execução em cada uma dessas fases. No entanto, alguns erros comuns de execução são apontados com algum consenso como deslizar muito curto, não alcançar o pike, abaixar as pernas muito rápido após o pike e flexionar os cotovelos na tentativa de encerrar o movimento. CONCLUSÃO: Há um número reduzido de estudos que integram a avaliação biomecânica ao processo ensino-aprendizagem na ginástica, bem como no contexto do esporte de alto rendimento. Demonstramos que essa abordagem qualitativa pode ser útil para o processo de ensino-aprendizagem desse exercício específico. A decomposição do movimento em fases permite estabelecer prioridades com base nas forças e fraquezas apresentadas pelos atletas / alunos, otimizando assim as intervenções para melhorar o seu desempenho. (AU)

Kip is a fundamental skill widely used in artistic gymnastics trai-ning routines. However, there is a lack of didactic material that helps students' tea-ching-learning process and beginning teachers. OBJECTIVE: To present a qualitative biomechanical analysis of the kippe performed on the lower bar of the asymmetric parallel bars. METHODS: This was an narrative review based on Google Scholar. The terms used to search for materials were kippe and biomechanics, in Portuguese and English, considering experimental and nonexperimental studies. RESULTS: The lite-rature points out different terms to designate this same movement. The predominant articular movements are extension and flexion, which justifies the majority of the texts to approach the sagittal plane analysis. The kippe has six instants and three phases of movement, Glide, Pike, and Pull Up. The literature show small differences in executi-on in each of these phases. However, some common execution errors are pointed out with consensus as glide too short, do no reach the pike, lower the legs too fast after the pike, and flexing the elbows in an attempt to end the movement. CONCLUSION: The-re is a low number of studies that integrate biomechanical assessment with the tea-ching-learning process in gymnastics, as well as in the context of high-performance sport. We have demonstrated that this qualitative approach might be useful to the tea-ching-learning process of this specific exercise. The decomposition of the movement in critical phases allows establishing priorities based on the strengths and weaknesses exhibited by the athletes/students, thereby optimizing the interventions to improve their performance. (AU)

Antiphospholipid antibodies and idiopathic infertility.

OBJECTIVE: The aim of our study was to evaluate obstetric outcome of women affected by idiopathic infertility showing persistently positive antiphospholipid antibodies (aPL). METHODS: : From 2000 consecutive patients undergoing ART, we selected 151 (7.55%) clinical records of patients affected by idiopathic infertility undergoing ICSI and showing positive aPL. RESULTS: Persistently positive aPL were found in 64/151 (42.38%) of the patients: in 34/64 (53.12%) at medium/high titers (group A) and in 30/64 (46.87%) at low titers (group B). Primary or secondary antiphospholipid syndrome (APS) was diagnosed in 25% of the patients, whereas 37.5% women showed clinical and/or laboratory features suggestive of APS, but not fulfilling clinical or laboratory classification criteria. Idiopathic infertility was the sole symptom in 31.25%. In 55% of these infertile patients, a history of recurrent failures of assisted reproductive techniques (ART) was also observed. Eighty-eight percent (88.88%) of women became pregnant and 77.77% gave birth. During pregnancy, an increase of aPL values was observed in 29.41% women of group B. CONCLUSIONS: A careful selection of patients allowed us to confirm that women affected by idiopathic infertility show a high prevalence of aPL, suggesting that these autoantibodies can also affect conception. Considering pregnancy complications and thrombotic risk related to ovarian stimulation, measuring aPL can represent a valid tool to identify among infertile women undergoing ART those at higher risk of pregnancy complications potentially life-threatening for mother and the fetus. In such patients, an accurate diagnosis and an adequate therapy are related to a better ART outcome.

Factors Affecting the Outcome of Symptomatic Carotid Stenosis Surgical Treatment in a Single Center Series.

BACKGROUND: The aim of this study is to evaluate the role of preoperative ischemic brain lesion (IBL) volume, assessed by Diffusion-weighted magnetic resonance brain imaging (DW-MRI) with RAPID® processing, and surgery timing in predicting post-operative neurological outcomes in symptomatic carotid stenosis (SCS) patients treated with carotid endarterectomy (CEA). MATERIALS AND METHODS: All patients with SCS who underwent CEA between January 2010 and June 2020 were considered. IBLs ipsilateral to the stenosis were identified in the preoperative magnetic resonance brain (MRI). The volume was quantified in mL and correlated with 30-day rates of stroke and stroke/death by χ2 and receiver operating characteristic (ROC) curve. RESULTS: One hundred thirty-four patients were surgically treated for SCS during the entire study period. CEA procedures were defined as emergent, urgent, or elective if performed within 48 hr, between 48 hr and 14 days, or after 14 days from symptoms onset, respectively. Cumulative new ipsilateral stroke rate was 4,5%, with a statistically higher neurological complications in emergent patients compared to urgent and elective patients (10,6%, 1,47% and 0% respectively, P 0,039). ROC curve analysis showed a volume of 10 mL was predictive of postoperative stroke with 100% sensitivity and 80% specificity. An IBL volume >10 mL was an independent risk factor for postoperative stroke. In fact, the perioperative neurological complication rate was significantly different in high-IBL volume patients (>10 mL) compared with low-IBL volume patients (<10 mL) (P 0,003) CONCLUSIONS: The present study suggests that the optimal timing for CEA is between 48 hr and 14 days. Furthermore, the present study suggests that the presence of the IBL, by itself, is not definitively related with an unsatisfactory neurological outcome. However, an IBL higher than 10 mL should be as a reliable threshold value adverse neurological result in SCS patients.

Neutrophil-to-Lymphocyte Ratio Could Predict Outcome in Patients Presenting with Acute Limb Ischemia.

INTRODUCTION: Acute limb ischemia (ALI), classified according to Rutherford's classification (RC), is a vascular emergency burdened by high rates of mortality and morbidity. The need of new and different prognostic values for ALI has emerged, and, among all, the neutrophil-to-lymphocyte ratio (NLR) has been proven as a strong outcome predictor in vascular disease. The aim of this study is to investigate the role of preoperative NLR in predicting clinical outcomes in patients presenting acute limb ischemia. MATERIAL AND METHODS: A single-center retrospective study was conducted between January 2015 and December 2019. Demographic and clinical characteristics, procedural technical aspects, postoperative and early (up to 30-day) outcomes were recorded. All enrolled patients were categorized into low- and high-NLR at baseline, using a cut-off value of 5. Study outcomes were 30-day all-cause mortality and amputation rates. RESULTS: A total of 177 ALI patients were included in the final analysis (6 RC I, 44 RC IIA, 108 RC IIB, and 19 RC III), 115 males (65%), mean age 78.9 ± 10.4 years. Mean NLR at hospital presentation was 6.65 ± 6.75 (range 0.5-35.4), 108 (61.1%) patients presented a low-NLR, 69 (38.9%) a high-NLR. Immediate technical success was achieved in 90.1% of cases. At 30 days, freedom from amputation and freedom from death rates were 87.1% and 83.6%, respectively. At the univariate analysis, amputation (p < 0.0001, OR: 9.65, 95%CI: 3.7-25.19), mortality (p = 0.0001, OR: 9.88, 95%CI: 3.19-30.57), and cumulative event rates (p < 0.001, OR: 14.45, 95%CI: 6.1-34.21), were significantly different between the two groups according to NLR value. Multivariate analysis showed that a high baseline NLR value was an independent predictor of unfavorable outcomes in all enrolled patients. Consistently, at ROC analysis, a preoperative NLR > 5 was strongly associated with all outcome occurrences. CONCLUSION: Preoperative NLR value seems to be strongly related to ALI outcomes in this unselected population. The largest series should be evaluated to confirm present results.

In vitro and in vivo anti-inflammatory activity and chemical composition of Renealmia petasites Gagnep.

The study aimed to investigate the chemical composition and the anti-inflammatory activity of the hydroethanolic rhizomes, stems, and leaf extracts of Renealmia petasites using in vitro and in vivo assays. The chemical composition of the extracts was characterized in a linear iron trap mass spectrometer. Total phenolic, flavonoid, and tannin content were determined by spectrophotometry analyses. In vitro anti-inflammatory activity was investigated in lipopolysaccharide-stimulated macrophages evaluating the influence on the production of superoxide anion (O2-), nitric oxide (NO), and the pro-inflammatory cytokines tumor necrosis factor (TNF-α) and interleukin-6 (IL-6). In vivo effects were determined using the air pouch model in which were inoculated carrageenan and thereafter treated with 50 mg/kg of the hydroethanolic extracts of R. petasites. After 4 and 24 h, the cellular influx, protein exudation, cytokines, and nitric oxide were evaluated. Eight compounds were tentatively identified in the R. petasites extracts, suggesting five diarylheptanoids, one flavonoid, and two fatty alcohols. The in vitro results showed that the extracts were capable of blocking free radicals and/or inhibiting their intracellular actions by inhibiting the production of important mediators of the inflammatory process, such as NO, O2-, TNF-α, and IL-6. In vivo, R. petasites significantly decrease the influx of leukocytes, mainly neutrophils, protein exudation, NO, TNF-α, and IL-6 concentration in the air pouch model. The results evidenced that R. petasites can be considered a promising alternative therapy for the treatment and management of osteoarthritis and other inflammatory diseases.

Validity of an Interval Taekwondo-Specific Cardiopulmonary Exercise Test.

ABSTRACT: Araujo, MP, Soares, PP, Hausen, MR, Julio, HS, Porto, F, and Gurgel, JL. Validity of an interval taekwondo-specific cardiopulmonary exercise test. J Strength Cond Res 35(7): 1956-1963, 2021-The objective of this study is to propose and validate an interval taekwondo-specific cardiopulmonary exercise test (ITKDtest) and compare it with running cardiopulmonary exercise test (CPET) and a continuous taekwondo-specific cardiopulmonary exercise test (CTKDtest). Fifteen athletes (age 22 ± 4 years; body mass 71.1 ± 10.2 kg; height 178.14 ± 8.3 cm; and body mass index 22.4 ± 2.4 kg·m-2) performed CPET, CTKDtest, and ITKDtest on a counterbalanced order. Oxygen uptake (V̇o2), heart rate (HR), and ventilatory thresholds (VTs 1 and 2) were measured during the 3 tests. ITKDtest started at 30 kicks per minute and increased 10 kicks each 2 minutes, with a period of passive recovery, lasting 1 minute. Interval protocol design simulated the temporal structure of an official taekwondo fight. Significant difference between specific tests was found for V̇o2 VT1 (p = 0.03), V̇o2 VT1 (%V̇o2peak) (p = 0.009), V̇o2 VT2 (p = 0.005), and V̇o2 VT2 (%V̇o2peak) (p = 0.013). Reliability was considered "excellent" for V̇o2peak (α = 0.902; SEM = 0.179), "good" for V̇o2 VT1 (α = 0.708; SEM = 3.823) and HRpeak (α = 0.803; SEM = 2.987), and "fair" for V̇o2 VT2 (α = 0.659; SEM = 4.498) and HR VT2 (α = 0.580; SEM = 8.868). Bland-Altman analyses reported a mean difference of 2.9 ± 6.6 ml·kg-1·min-1 (CPET-ITKDtest) and 1.4 ± 6.1 ml·kg-1·min-1 (CTKDtest-ITKDtest). ITKDtest may be used for measurement of cardiorespiratory variables commonly used in exercise prescription, whereas CTKDtest seems to be a more appropriate method to assess V̇o2 and HR at VTs.

Effect of Dance on Postural Control in People with Parkinson's Disease: A Meta-Analysis Review.

This systematic review verified the effect of dance on postural control in people with Parkinson's disease (PD) and investigated whether this practice can be as effective over a short period as when it is performed over a longer period in relation to the postural control of this population. The search was performed in April 2019 in nine databases. Only randomized/quasi-randomized controlled trials with participants with idiopathic PD were included. The meta-analysis of the 11 articles included, with 13 results, showed that the 211 participants with PD, who belonged to the group performing dance, had a standardized mean difference of postural control 0.82 [0.52, 1.12] greater than the 182 participants who were in a control situation. The statistically significant results of this meta-analysis indicate that dance can improve postural control in people with PD in a short period of time and therefore contribute to the prevention of falls.

Psychological Distress in Patients with Autoimmune Arthritis during the COVID-19 Induced Lockdown in Italy.

Lockdowns imposed by governments worldwide as a way to limit the spread of severe atypical respiratory syndrome-coronavirus-2 (SARS-CoV2) have had heavy psychological and economic consequences. Arthritis patients are a vulnerable population at an increased risk of peritraumatic stress. This could be due to several reasons, including the fear of shortage of medicine and difficulty receiving periodical medical checks. In the present case-control study, psychological distress in patients with autoimmune arthritis during the coronavirus disease 2019 (COVID-19) pandemic were investigated. An electronic survey was conducted to gather information on the perceived change in the emotional state, general health (GH), fatigue, joint pain, and disease activity during the lockdown, in 100 patients with autoimmune arthritis and 100 controls. Mental health status was measured using the Depression, Anxiety and Stress Scale (DASS-21). The COVID-19 Peritraumatic Distress Index (CPDI) was used to assess the frequency of peritraumatic stress disorders related to COVID-19. Patients reported a significant worsening of perceived GH (36% vs. 7%; p < 0.001), a significantly higher mean CPDI score (p < 0.001) than controls. Using multivariate analysis, arthritis patients had significantly higher CPDI scores (+3.67 points; p = 0.019), independent of depression, anxiety, and stress symptoms, comorbidities, and sociodemographic and lifestyle characteristics. Logistic regression analysis showed that the risk of reporting worsened GH was 9-fold higher in patients than controls (p < 0.001). Patients with autoimmune arthritis are at higher risk of psychological distress related to COVID-19 pandemic; thus targeted intervention should be designed to strengthen coping capacity in this vulnerable population.

Coinfection of Tuberculosis Pneumonia and COVID-19 in a Patient Vaccinated with Bacille Calmette-Guérin (BCG): Case Report.

COVID-19 is a respiratory tract infection caused by the new coronavirus SARS-COV2 that can be complicated by acute distress respiratory syndrome and multiorgan failure. In light of the high rate of mortality associated with COVID-19, pharmacological and non-pharmacological strategies to prevent the infection are currently being tested. Among non-pharmacological preventive measures, vaccines represent one of the main resources for public health. It has been suggested that Bacille Calmette-Guérin (BCG) vaccine may protect individuals against infection from COVID-19 virus, and two clinical trials addressing this question are underway. Here, we report the case of a 32-year-old woman, vaccinated with BCG when she was 1 year old, who was diagnosed with apical tuberculous pneumonia of the right lung along with COVID 19 pneumonia.

NLRP12 gene mutations and auto-inflammatory diseases: ever-changing evidence.

Systemic auto-inflammatory diseases (SAID) are a group of rare inherited conditions characterized by a dysregulation of the immune system and associated with recurrent episodes of fever and systemic inflammation. Patients with NLRP12 variants develop a rare autosomal dominant condition known as familial cold-induced autoinflammatory syndrome (FCAS2, OMIM #611762) that has been related to several different clinical manifestations including autoimmunity and immune deficiencies. In past years, several new variants have been described; however, their clinical relevance is sometimes uncertain, especially when they have been detected in healthy subjects. To our knowledge 61 patients with NLRP12 variants have been reported so far in the literature. Here we report the case of a 33-year-old woman with a history of recurrent fever and symmetric and additive poly-arthritis, fulfilling diagnostic criteria for RA, who was found to harbour two variants in the NLRP12 gene (OMIM *609648) and provide a review of the literature on similar cases.

Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug-Drug Interactions in Out- and Inpatients Exposed to Polypharmacy.

BACKGROUND: Polypharmacy exposes patients with comorbidities (particularly elderly patients) to an increased risk of drug-specific adverse events and drug-drug interactions. These adverse events could be avoided with the use of a computerized prescription support system in the primary care setting. The INTERCheck® software is a prescription support system developed with the aim of balancing the risks and benefits of polytherapy and examining drug-drug interactions. OBJECTIVES: This observational study used the INTERCheck® software to evaluate the incidence of adverse events and of drug-drug interactions in outpatients and inpatients receiving multiple medications. METHODS: Patients were randomly enrolled from the outpatient department (n = 98) and internal medicine ward (n = 46) of S. Andrea Hospital of Rome. Polypharmacological treatment was analyzed using INTERCheck® software, and the prevalence of risk indicators and adverse events was compared between the two groups. RESULTS: Polypharmacy (use of five or more drugs) applied to all except three cases among outpatients and one case among inpatients. A significant positive correlation was found between the number of medications and the INTERCheck® score (ρ = 0.67; p < 0.000001), and a significant negative correlation was found between the drug-related anticholinergic burden and cognitive impairment (r = - 0.30 p = 0.01). Based on the INTERCheck® analysis, inpatients had a higher score for class D (contraindicated drug combination should be avoided) than did outpatients (p = 0.01). The potential class D drug-drug interactions were associated with adverse events that caused hospitalization (χ2 = 7.428, p = 0.01). CONCLUSIONS: INTERCheck® analysis indicated that inpatients had a high risk of drug-drug interactions and a high percentage of related adverse drug events. Further prospective studies are necessary to evaluate whether the INTERCheck® software may help reduce polypharmacy-related adverse events when used in a primary care setting and thus potentially avoid related hospitalization and severe complications such as physical and cognitive decline.

Influence of stretching exercises in musculoskeletal pain in nursing professionals / Influência de exercícios de alongamento na dor musculoesquelética em Profissionais de Enfermagem / Influencia de ejercicios de estiramiento en el dolor musculoesquelético en profesionales de la enfermería

Abstract Introduction: Nursing professionals (NPs) experience musculoskeletal pain that leads them to leave work. Objective: To analyze the effects of muscle stretching exercises (MSE) on pain among NPs. Method: This is a randomized controlled parallel experiment, in which 28 NPs (7 men and 21 women) were allocated into experimental (EG, n = 15; 47.4 years ± 9.5) and control (CG, n = 13; 39.15 years ± 9.6) groups. MSEs were performed for two months, three days a week, 40 min per session. A visual numeric scale was used, for which the intensity ranged from 0 (no pain) to 10 (maximum pain). The research was registered at the Brazilian Clinical Trials Registry website (TRIAL: RBR- 8chg6q). For statistics, the Shapiro-Wilk, T-independent and two-way ANOVA tests were applied for repeated measures with Tukey's post-hoc test (P ≤ 0.05). Results: Most NPs work on weekends (68%) and/or have other professional activities (60.7%); 42.9% had to miss work at least once in the year prior to the survey and 66.7% of those were due to medical reasons; 42.9% work more than 10 hours/day. Of the NPs, 89.3% of the volunteers in both groups lived daily with pain in some region of the body. Pain decreased after the MSE program was initiated in the EG (p = 0.001) and differed from the CG (p = 0.002). Conclusion: MSEs were beneficial for pain reduction in NPs.

Resumo Introdução: um número elevado de Profissionais de Enfermagem (PEF) sentem dor em alguma região do corpo, principalmente na região lombar, o que muitas vezes acaba afastando-os de suas atividades laborais. Objetivo: analisar os efeitos de e exercícios de alongamento muscular (EAM) na dor em Profissionais de Enfermagem (PEF). Método: realizou-se um experimento clínico, controlado e randomizado, de desenho paralelo, com uma amostra de 28 PEF (7 homens e 21 mulheres), com idades entre 18 e 60 anos, divididos, aleatoriamente, em grupo experimental (GE: n = 15) e grupo controle (GC: n = 13). Os EAM foram oferecidos por dois meses, em três dias semanais. As sessões de EAM tiveram duração de 40 min compostas por exercícios ativos e estáticos de alongamento. Cada exercício foi repetido por 4 séries de 30s, com intervalo de 30s entre elas. Para a medição de dor nos PEF, foi usada uma escala visual numérica, na qual a intensidade variava entre 0 (ausência de dor) a 10 (máxima intensidade de dor). Essa medição era feita antes, logo após e ao término do programa de oito semanas de EAM. A presente pesquisa foi registrada no portal de Registro Brasileiro de Ensaios Clínicos (TRIAL: RBR- 8chg6q). Resultados: para interação grupo x dor, notou-se que houve diferença significativa (F = 6,5; p = 0,002) e, que, somente, para o GE, as dores aguda e crônica foram, significativamente, menores que a dor inicial (p = 0,001). Conclusão: o alongamento produziu efeitos agudo e crônico positivos na redução da dor em PEF.

Resumen Introducción: un alto número de profesionales de enfermería (PEF) sienten dolor en alguna región del cuerpo, especialmente en la región lumbar, que a menudo termina alejándolos de sus actividades laborales. Objetivo: analizar los efectos de los ejercicios de estiramiento muscular (EEM) en el dolor en los Profesionales de Enfermería (PEF). Método: se llevó a cabo un experimento clínico, controlado y aleatorio, de diseño paralelo, con una muestra de 28 PEF (7 hombres y 21 mujeres), con edad entre 18 y 60 años, divididos aleatoriamente en un grupo experimental (GE: n = 15) y un grupo de control (GC: n = 13). Los EEM se ofrecieron durante dos meses, en tres días de la semana. Las sesiones de EEM duraron 40 minutos compuestos de ejercicios de estiramientos activos y estáticos. Cada ejercicio se repitió por 4 series de 30s, con un intervalo de 30s entre ellos. Para la medición del dolor en los PEF, se utilizó una escala visual numérica, en la que la intensidad osciló entre 0 (ausencia de dolor) y 10 (intensidad máxima del dolor). Esta medición se realizó antes, poco después y al final del Programa de ocho semanas de los EEM. Esta investigación se registró en el portal de Registro Brasileño de Ensayos Clínicos (TRIAL: RBR- 8chg6q). Resultados: para la interacción del grupo x del dolor, se observó que había una diferencia significativa (F = 6,5; p = 0,002) y que solo para el GE, el dolor agudo y crónico era significativamente menor que el dolor inicial (p = 0,001). Conclusión: el estiramiento produjo efectos agudos y crónicos positivos en la reducción del dolor de los PEF.

Motivos da adesão de idosos às Academias da Terceira Idade / Reasons for the adherence of older adults to Gyms for Seniors

Resumo Verificar os motivos de adesão (ingresso e permanência) de idosos às Academias da Terceira Idade (ATI) da cidade do Rio de Janeiro, RJ, Brasil. Método: Foram entrevistados 396 idosos de ambos os sexos, com idade igual ou superior a 60 anos, frequentadores de 58 ATIs representativas de todas as regiões programáticas dessa cidade. Os dados foram coletados utilizando-se questionário validado e analisados por meio de estatística descritiva. Resultado: Os resultados indicaram como motivos predominantes para justificar o ingresso dos idosos nas ATIs aqueles relacionados à saúde (Evitar problemas de saúde: 26%; O médico aconselhou: 16%), enquanto que os de permanência estão mais associados com questões sociais (Gosto do professor e Me faz sentir bem: 100%) e com a percepção dos benefícios do exercício físico (É uma atividade física saudável: 100%) Conclusão: Embora os motivos ligados à saúde figurem como importantes para os idosos ingressarem no programa, a sua permanência depende do gosto que eles têm pela atividade.

Abstract Objective: to verify the reasons behind the adherence (entry and permanence) of older adults to Gyms for Seniors (GFSs) in the city of Rio de Janeiro. Method: a total of 396 men and women over the age of 60 were interviewed for this study. The subjects frequented 58 different GFSs from all the administrative regions of the city of Rio de Janeiro. The data was collected with a validated questionnaire and analyzed through descriptive statistics. Results: the results indicated that the main reasons which explain the older population entering the GFSs are to do with health (Avoiding health problems: 26%; Doctor's orders: 16%) while their permanence is more associated with social factors (I like the teacher and It makes me feel good, both with 100%) and their perception of the benefits of exercise (It is a healthy physical activity: 100%). Conclusion: although health reasons are important for the older adults who enter the program, they mostly remain due to how much they like the activities.

Transcranial direct-current stimulation in combination with exercise: a systematic review / Estimulação transcraniana por corrente contínua em combinação com o exercício: uma revisão sistemática / Estimulación transcraneana por corriente continua en combinación con el ejercicio: una revisión sistemática

ABSTRACT Introduction Transcranial direct-current stimulation (tDCS) is a noninvasive technique that allows the modulation of cortical excitability and can produce changes in neuronal plasticity. The application of tDCS has recently been associated with physical activity. Objectives To verify the effect of Transcranial Direct-Current Stimulation (tDCS) in combination with physical exercise, characterizing methodological aspects of the technique. Methods In the database search, studies with animals, other neuromodulation techniques and opinion and review articles were excluded. Publications up to 2016 were selected and the methodological quality of the articles was verified through the PEDro scale. Results The majority of studies (86%) used tDCS on the motor cortex area, with anodal current and the allocation of monocephalic electrodes (46.5%). The prevalent current intensity was 2mA (72%), with duration of 20min (55.8%). The profile of the research participants was predominantly of subjects aged up to 60 years (72.1%). The outcomes were favorable for the use of anodal tDCS in combination with physical exercise. Conclusion Transcranial Direct-Current Stimulation is a promising technique when used in combination with aerobic and anaerobic exercises; however, it is necessary to investigate concurrent exercise. Level of Evidence II; Therapeutic Studies Investigating the Results of Treatment (systematic review of Level II studies or Level I studies with inconsistent results).

RESUMO Introdução A estimulação transcraniana por corrente contínua (ETCC) é uma técnica não invasiva que permite a modulação da excitabilidade cortical e pode produzir alterações na plasticidade neuronal. A aplicação da ETCC tem sido recentemente associada à atividade física. Objetivos Verificar o efeito da Estimulação Transcraniana por Corrente Contínua (ETCC) em combinação com o exercício físico, caracterizando os aspectos metodológicos da técnica. Métodos Na busca em base de dados, excluíram-se estudos com animais e outras técnicas de neuromodulação, além de artigos de revisão e opinião. Foram selecionadas publicações até 2016 e a qualidade metodológica dos artigos foi verificada através da escala PEDRo. Resultados A maioria dos estudos (86%) utilizou a ETCC na área do córtex motor, com corrente anódica e montagem monocefálica (unipolar) (46,5%). A intensidade da corrente dominante foi 2mA (72%) com duração de 20 min (55,8%). O perfil dos participantes da pesquisa foi predominantemente de indivíduos com até 60 anos de idade (72,1%). Os desfechos foram favoráveis ao uso da ETCC anódica em combinação com o exercício físico. Conclusão A Estimulação Transcraniana por Corrente Contínua é uma técnica promissora quando utilizada em combinação com os os exercícios aeróbicos e anaeróbicos; entretanto, é necessário investigar o exercício concomitante. Nível de evidência II; Estudos terapêuticos investigando os resultados do tratamento (revisão sistemática dos estudos de nível II ou estudos de nível I com resultados inconsistentes).

RESUMEN Introducción La estimulación transcraneana por corriente continua (ETCC) es una técnica no invasiva que permite la modulación de la excitabilidad cortical y puede producir alteraciones en la plasticidad neuronal. La aplicación de la ETCC ha sido recientemente asociada a la actividad física. Objetivos Verificar el efecto de la Estimulación Transcraneana por Corriente Continua (ETCC) en combinación con el ejercicio físico, caracterizando los aspectos metodológicos de la técnica. Métodos En la búsqueda en base de datos, se excluyeron estudios con animales y otras técnicas de neuromodulación, además de artículos de revisión y opinión. Fueron seleccionadas publicaciones hasta 2016 y la calidad metodológica de los artículos fue verificada a través de la escala PEDRo. Resultados La mayoría de los estudios (86%) utilizó la ETCC en el área del córtex motor, con corriente anódica y montaje monocefálico (unipolar) (46,5%). La intensidad de la corriente dominante fue 2mA (72%) con duración de 20 min (55,8%). El perfil de los participantes de la investigación fue predominantemente de individuos con hasta 60 años de edad (72,1%). Los desenlaces fueron favorables al uso de la ETCC anódica en combinación con el ejercicio físico. Conclusión La Estimulación Transcraneana por Corriente Continua es una técnica alentadora cuando utilizada en combinación con los ejercicios aeróbicos y anaeróbicos; entretanto, es necesario investigar el ejercicio concomitante. Nivel de evidencia II; Estudios terapéuticos investigando los resultados del tratamiento (revisión sistemática de los estudios de nivel II o estudios de nivel I con resultados inconsistentes).